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Johns Hopkins International Injury Research Unit

A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

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Keyword: trauma care

On May 14, 2018, the Johns Hopkins International Injury Research Unit (JH-IIRU) hosted a panel of trauma and emergency care experts at the Johns Hopkins Bloomberg School of Public Health as part of its ongoing 10th anniversary year. The event, “Trauma and Emergency Care across the Lifespan,” featured multidisciplinary trauma experts JH-IIRU associate director Amber Mehmood and senior technical advisor Junaid Razzak, as well as Safe Kids Worldwide founder Dr. Martin Eichelberger.

JH-IIRU director Adnan A. Hyder welcomed participants—watching both in-person and via a streaming webcast—to the event before deputy director Abdul M. Bachani introduced each panelist and facilitated discussion at the conclusion of each presentation.

Razzak led off the series of speakers with a presentation on emergency care in Pakistan. In his talk, he outlined the definition of an emergency care system and focused on Karachi, Pakistan—the third-largest city in the world.

Mehmood followed with a talk on trauma care in low-income countries and shared a case study on traumatic brain injury (TBI) across the lifespan in Uganda. She shared new results from a collaborative effort with JH-IIRU and Makerere University: a third of all patients presenting with TBI suffered a drop in the Glasgow Coma Scale (GCS), a critical indicator, during emergency department stay. This finding, Mehmood remarked, should lead to improved assessment and interventions.

Dr. Eichelberger, in the final presentation of the event, discussed pediatric trauma. From his work at Children’s National Medical Center and Safe Kids Worldwide, Dr. Eichelberger shared childhood injury statistics both domestically and globally.

In 2018, the Johns Hopkins International Injury Research Unit is celebrating its first decade of innovation and research in global injury prevention and control. To honor the anniversary, JH-IIRU is hosting a number of special events throughout the year. To learn more about the Unit and its 10th anniversary, please click here.

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Dr. Martin Eichelberger presents on pediatric trauma during JH-IIRU’s 10th anniversary event, “Trauma and Emergency Care across the Lifespan,” at the Johns Hopkins Bloomberg School of Public Health on May 14, 2018.

Johns Hopkins International Injury Research Unit (JH-IIRU) Associate Director and Assistant Scientist Amber Mehmood, MD represented the Unit and School at the Global Alliance for the Care of the Injured (GACI) meeting on May 7-8, 2018 at World Health Organization (WHO) headquarters in Geneva, Switzerland.

On behalf of the Unit, Mehmood presented JH-IIRU’s portfolio of research and work related to trauma and emergency care, including the development and implementation of trauma registries, capacity development, and assessment of trauma and emergency care systems.

“As a World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention, our Unit is dedicated to responding to the growing burden of injuries worldwide,” said Mehmood. “Our affiliation with the Global Alliance for the Care of the Injured is key to meeting with other committed researchers to identify and implement effective solutions and influence public policy and practice in injury prevention across the globe.”

Mehmood and her colleagues in GACI’s Data and Quality improvement workgroup convened for sessions in which they focused on minimal dataset for injuries and the finalization of metadata for a WHO trauma registry.

To learn more about GACI, please click here. To learn about JH-IIRU and its role as a WHO Collaborating Center for Injuries, Violence and Accident Prevention, please click here.

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World Health Organization Coordinator Dr. Nhan Tran presents on the United Nations Road Safety Collaboration at the meeting of the Global Alliance for the Care of the Injured on May 7-8, 2018 in Geneva, Switzerland.

Road traffic injuries (RTIs) are a leading cause of death and disability in Africa. With a rate of 28.3 fatalities per 100,000 population, it’s the highest in the world. What’s more, the economic cost of RTIs on the continent is estimated to be 1-2% of the gross national product. Despite these high numbers, there is little data available on prevention and treatment strategies.  This is true for the central African country of Cameroon, where the number of road traffic deaths has been steadily increasing since the 1970s.

Recently, in an effort to examine road traffic injuries JH-IIRU team members published “Road Traffic Injuries in Yaoundé, Cameroon: A hospital-based pilot surveillance study,” in the journal Injury. The paper looked at patients injured in RTIs who sought care at the main referral hospital in Yaoundé to determine not only the characteristics of those injured but also to identify the associations between these characteristics and outcomes which could be used to improve treatment in Cameroon as well as  other low- and middle-income countries (LMICs). The study provides valuable information about RTIs which the team hopes can be used to improve emergency care in Cameroon and other LMICs and highlights the importance of RTI prevention.

The team included JH-IIRU associate director, Kent Stevens and director Adnan Hyder, and colleagues from WHO Africa, the Ministry of Public Health in Yaoundé, as well as the Department of Surgery at the University of California, San Francisco.  Catherine Juillard, currently in the Department of Surgery at Johns Hopkins Hospital, was a post-doctoral fellow in JH-IIRU when this study was conducted.

This study is part of the unit’s ongoing global work on trauma care.

Read more here

Injury severity scores are important and necessary tools for both evaluating care of the injured patient and establishing institutional quality and research practices. In high-income countries (HICs), several injury severity scores have been used to evaluate and study trauma patients; however, despite the fact that more than 90% of the estimated 5.8 million deaths each year caused by injury worldwide occur in low- and middle-income countries (LMICs), few scores have been validated for use in these countries.  The Kampala Trauma Score (KTS) is an injury severity score that was developed specifically for use in low-resource settings.

In the recently published paper, “Is the Kampala Trauma Score an Effective Predictor of Mortality in Low-Resource Settings? A Comparison of Multiple Trauma Severity Scores,” a group of researchers, including Johns Hopkins International Injury Research Unit’s (JH-IIRU) associate director, Kent Stevens and director, Adnan Hyder, compared five trauma severity scores against the ability of KTS to predict mortality of trauma patients in the Central Hospital of Yaounde, Cameroon.

The results suggest that there is potential for the adoption of KTS for injury surveillance and triage in resource-limited settings and that KTS is as effective as other scoring systems in predicting patient mortality. Because the system is simple to administer and record, this makes KTS a potentially valuable tool for low-resource settings, where many hospitals are understaffed and basic record-keeping and data collection is unreliable or incomplete.

To read more about the study, click here.

Emergency care in Pakistan suffers from critical gaps in both essential equipment and provider knowledge necessary for effective emergency and trauma care.  Those are the findings of a recent study undertaken in the country’s Sindh province by the Johns Hopkins International Injury Research Unit (JH-IIRU) in collaboration with colleagues at Aga Khan University’s Department of Emergency Medicine.

The study, “Emergency and trauma care in Pakistan: A cross-sectional study of healthcare levels,” published in Emergency Medicine Journal, used the World Health Organization’s (WHO) assessment protocols—the Guidelines for essential trauma care and the Prehospital care systems—to evaluate emergency and trauma care at different levels of health facilities in Pakistan. The study focused on two specific aspects: 1) infrastructure and essential equipment and supplies and 2): availability and knowledge of physicians providing emergency care.

The findings suggested that both facility-level equipment and supplies and human resource gaps exist in the current emergency care system in the country—gaps that are likely to compromise the level of emergency care—and point to the need for comprehensive reform of the emergency care system in the province of Sindh.  The study also provided a set of recommendations, which include increasing the investment in health provider training for acute care, providing facilities with low-cost commonly-used supplies such as bag valve masks and integrating improved emergency care protocols.

The study was partly supported by the NIH-Fogarty funded Johns Hopkins-Pakistan International Collaborative Trauma and Injury Research Training Program (JHU-Pakistan ICTIRT).

To read more, click here.

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